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NHS Scotland is a wholly devolved, and controlled by the Scottish parliament. It is a health system that has consistently outperformed other NHS services throughout the UK. In an independent Scotland, this autonomy would continue, and any budget would solely be constrained by any future Scotland Government, and not subject to budget changes via the Barnett Formula from the UK Government. Parties in Scotland have committed that these services will remain free at the point of delivery, and a public service.
A new clinical strategy that recommends major changes to existing services will transform the way healthcare is provided in Scotland.
Under the plans announced by the health secretary, Shona Robison, primary care would be delivered by multidisciplinary teams, integrated with social services.1 GPs would focus on complex cases and give expert assessment of new cases.
Most hospitals would still deliver outpatient, diagnostic, and day case surgical services, but specialist services would be available at fewer sites. This is based on evidence that outcomes were better in specialist centres. It was proposed that networks of smaller and rural hospitals would be established, with clinicians working in more than one hospital.
A 'new clinical paradigm' was also recommended for the care of patients. The least invasive or disruptive processes would be used as the first step and clinicians would seek to avoid wasteful investigations and treatments that do not benefit patients. Treatments would be closely tailored to the preferences of patients, who would be supported to make decisions about their own care.
The strategy document identified the changes needed over the next 10-15 years, and said that, 'These changes are complex, and require consideration of workforce resources, potential outcomes, inter-relationships between specialties, and finance. It will require careful yet thorough conversations with the public and their representatives. However, failure to change will limit the potential to build on world class standards of care.'
It acknowledged that there were problems in recruiting staff and that there were funding pressures that constantly surrounded the provision of healthcare. However, it said that resources should not be the determining factor. 'World comparisons show that increasing expenditure on health services does not always bring about proportionate improvements in health. This strategy proposes that a continuous drive to deliver services of the highest quality and value is a more important and appropriate way of managing resources than an isolated focus on finance,' said the report.
The recognition of the pressures on the services was welcomed by Peter Bennie, chair of BMA Scotland. He said, 'The challenge for all of us with a stake in the future of Scotland's health service is finding the right way forward to secure our NHS for generations to come. This new strategy should provide a launch pad for these vital discussions.
'Doctors and healthcare professionals are determined to play an active role in the public debate on the future of the health service, but it is critical that the proposed solutions that politicians put forward now are realistic and deliver an NHS that is fit for the future.'